Multiple pregnancy

Question 1

Best outcome for twin pregnancy is seen in…

Answer 1

Dichorionic, diamniotic twin

Question 2

Types of twin pregnancies

Answer 2

• Dichorionic, dizygotic
• Dichorionic, monozygotic
• Monochorionic, monozygotic

Question 3

Multiple pregnancy is diagnosed when?

Answer 3

At booking scan

Question 4

Ultrasound scan sign for dichorionic diamniotic multiple pregnancy

Answer 4

Lambda sign

Question 5

Ultrasound scan sign for monochorinic diamniotic multiple pregnancy

Answer 5

T sign

Question 6

Risks to mother with twin pregnancy [7]

Answer 6

Anaemia

Miscarraige

Hypertension/ pre-eclampsia/ GDM

VTE

Pre-term birth

Labour: Instrumental delivery/ c-section/ PPH

Question 7

Risks to fetus in twin pregnancy

• All
• Monchorionic
• Monoamniotic

Answer 7

All

• Miscarriage/ stillbirth
• Malposition
• Foetal growth restriction
• Prematurity

Monochorionic

• Twin-twin transfusion syndrome (monochorionic)
• Twin anaemia polycythaemia sequence (TAPS)
• Congenital abnormalities (higher)
• Selective IUGR
• Twin reversed arterial perfusion sequence (TRAP)
• Death of a twin

Monoaminotic
- Cord enlargment

Question 8

Definition of small for gestational age

Answer 8

Estimated foetal weight / abdominal circumference < 10th percentile

Question 9

Definition of small for gestational age

Answer 9

Estimated foetal weight / abdominal circumference < 10th percentile

Question 10

Causes of symmetrical IUGR [4]

Answer 10

Chromosomal problem

Foetal infection

Inborn metabolic error

Structural problems

Question 11

Causes of asymmetrical IUGR

Answer 11

Placenta-mediated

• Pre-eclampsia
• Autoimmune disease
• Renal disease
• DM/ GDM
• Thrombophilia

Question 12

Risk factors for IUGR

Answer 12

Non-modifiable

• Age >40
• Nulliparity
• Previous SGA/ stillbirth
• Renal disease, antiphospholipid syndrome
• IVF
• PAPP-A <0.4

Modifiable

• Smoking
• DM
• High/ low maternal BMI
• Hypertension

Question 13

Foetal doppler looks at blood flow in…

Answer 13

Umbilical artery

Middle cerebral

Ductus venosus

Question 14

Neonatal complications of IUGR

Answer 14

Pre-term delivery

Meconium aspiration/ pulmonary hypertension

Hypoglycaemia

Polycythemia/ hyperviscosity

Mortality

Question 15

DCDA twins occur when the zygotes cleave during first ______ after fertilisation

Answer 15

3 days

Question 16

MCDA twins occur when the zygotes cleave during first ______ after fertilisation

Answer 16

4-8 days

Question 17

MCMA twins occur when the zygotes cleave during first ______ after fertilisation

Answer 17

8-12 days

Question 18

Antenatal care for twin pregnancy

Answer 18

• Obstetrician led + specialised twin midwife
• Increasing scanning (2-4 weeks)
• Birth planning

Question 19

Consequences of twin-twin perfusion sequency

Answer 19

Donor twin

• IUGR
• Reduced liquor

Recipient twin

• Fluid overload
• Cardiac failure
• Polyhydroaminos

Question 20

Uncomplicated DCDA twins are advised to be induced at…

Answer 20

37-38 weeks

Question 21

Uncomplicated MCDA twins are advised to be induced at….

Answer 21

36-37 weeks

Question 22

Mode of delivery for DCDA twins

Answer 22

If 1 baby cephalic= vaginal dilvery
- Risk of emergency c-section as second twin can malpresent

If first win is malpresenting= c-section